Influenze tra processo ed esiti: alleanza, coesione e cambiamento in un gruppo terapeutico a lungo termine
Outcomes – Process Connections: Alliance, Cohesion and Change in a Therapeutic Long Term Group
Research is currently moving in the direction of an integration between the outcome measures of the patients and the relational and/or structural factors that can facilitate their change. It is increasingly important to focus studies on the relationship between process and outcome, especially with regard to psychodynamic group therapy. These treatments, very complex and difficult to operationalize, still pose critical questions for research such as what are the main elements of the therapeutic process that are activated in these therapies?
Many efforts are to be made in understanding which factors develop in groups and the conditions that positively influence the success of therapy. Important is, moreover, the work of conceptual and "operational" depth on the different constructs, to better understand their nature and differences and build tools to more easily detect their features. Therapeutic alliance and cohesion are among the most investigated process variables, because of their role on the results of therapy. This study investigates these two variables in a therapeutic group with severe patients and analyzes their associations with treatment outcomes in term of symptoms and defenses. A long-term, semi-open group meeting on a weekly basis was examined. The observation was carried out for a period of 18 months, for a total amount of 50 sessions; 11 patients with different diagnoses in Axis I and II DSM IV were examined.
Outcome measures: SCL-90 - Symptom Check List; OQ-45 - Outcome Questionnaire 45.2; DSQ - Defense Style Questionnaire.
Process measures: CALPAS-G: California Psychotherapy Alliance Scale-Group; GMLCS: Group/Member/Leader Cohesion Scale.
The observation period was divided into 3 phases according to re-modulations of the setting (new entries, overcomes, dropout).
Significant correlations between alliance, cohesion and outcomes were found in the three phases. During the phase of greater instability, the predominant role of cohesion and, more generally, dimensions related to group commitment emerge.
Results offer interesting suggestions about the differentiation between Alliance and Cohesion and their different relationship with outcomes and process evolution.
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American Psychiatric Association (2001), DSM-IV-TR, Manuale diagnostico e statistico dei disturbi mentali - Text Revision, Masson, Milano
Abouguendia M., Joyce A.S., Piper W.E., Ogrodniczuk J.S. (2004). Alliance as a Mediator of Expectancy Effects in Short-Term Group Psychotherapy. Group Dynamics: Theory, Research, and Practice 8, ( 1), 3–12.
Bakali J. V., Hagtvet K. A., Hersoug A. G., Høglend P., Lorentzen S. Ruud, T. (2011). Psy-chodynamic Group Psychotherapy: Impact of Group Length and Therapist Professional Characteristics on Development of Therapeutic Alliance. Clinical Psychology & Psychotherapy 19(5):420-33.
Barlow SH (2008). La ricerca empirica e le terapie psicodinamiche di gruppo. In: Lo Coco, G, Prestano, C & Lo Verso, G (eds.), L'efficacia clinica delle psicoterapie di gruppo. Milano: Raf-faello Cortina.
Bond M, Gardner S. T., Christian J., & Sigal J. J. (1983). Empirical study of self-rated defence styles. Archives of General Psychiatry, 40, 333–338.
Bormann B, Burlingame GM & Strauss B (2011). Der Gruppenfragebogen (GQ-D) Instrument zur Messung von therapeutischen Beziehungen in der Gruppenpsychotherapie. Psychotherapeut, 56, 297–309.
Budman SH, et al. (1989). Cohesion, alliance and outcome in group psychotherapy, Psychiatry. 52, 339-350.
Burlingame GM, MacKenzie RK & Strauss B (2004). Small Group Treatment: Evidence for Effectiveness and Mechanisms of Change. In Lambert MJ (ed.), Bergin and Garfield's handbook of Psychotherapy and Behavior Change (5th ed.). New York: Wiley, 648-696.
Burlingame GM, McClendon DT & Alonso J (2011). Cohesion in Group Therapy. Psychotherapy, 48/1, 34 - 42.
Derogatis LR (1983). The Symptom Checklist -90 Revised: Administration, scoring and procedures manual II. Baltimore: Clinical Psychometric Research.
Dion K (2000). Group Cohesion: From “Fields of Forces” to Multidimensional Construct. Group Dynamics: theory research and practice, 4 (1), 7-26.
Gaston L, Marmar CR (1993). Manual of the California Psychotherapy Alliance Scales (CALPAS). Unpublished manuscript.
Gillaspy JA, Wright AR, Campbell C, Stokes S, Adinoff B., (2002), Group alliance and cohesion as predictors of drugs and alcohol abuse treatment outcomes. Psychoterapy Research, 12, pp. 213- 171.
Glatzer HT (1990). Psychoanalitic group psychotherapy. In: Cutash, IL & Wolf, A (eds.), The Group Psichotherapist's Handbook: Contemporaney Theory and Technique. Personality, Psycho-pathology: Theoretical and Clinical Perspectives. New York: Columbia University Press, 46-60.
Gullo S., Lo Coco G., Prestano C., Giannone F. & Lo Verso G. (2010). La ricerca in psicoterapia di gruppo: alcuni risultati e future direzioni di ricerca. In Ricerca in Psicoterapia / Research in Psychotherapy: Psychopathology, Process and Outcome, 2, 78-96.
Hornsey MJ, Dwyer L, Oei TP, Dingle GA (2009) Group processes and outcomes in group psychotherapy: is it time to let go of "cohesiveness"? International Journal of Group Psycho-therapy. 59/2, 267-278.
Horvath AO & Bedi RP (2003). The alliance. In J. Norcross (Ed.), Psychotherapy relations that work New York: Oxford. 37-70.
Johnson JE, et al. (2005). Group Climate, Cohesion, Alliance, and Empathy in Group Psycho-therapy: Multilevel Structural Equation Models, Journal of Counseling Psychology. 52/ 3, 310–321.
Joyce AS, Piper WE & Ogrodniczuk JS (2007). Therapeutic alliance and cohesion variables as predictors of outcome in short-term group psychotherapy. International Journal of Group Psychotherapy. 57/3, 269-296.
Kazdin AE (1992). Metodi di ricerca in psicologia clinica. Bologna: Il Mulino, trad. it. 1996.
Kipnes DR, Piper, WE & Joyce AS (2002). Cohesion and outcome in short-term psychodynamic groups for complicated grief. International Journal of Group Psychotherapy, 52, 483-509.
Kivlighan DMJ & Tarrant J M (2001) Does group climate mediate the group leadership-group member outcome relationship? A test of Yalom's hypotheses about leadership priori-ties. Group Dynamics: Theory, Research, and Practice, 5/3, 220-234.
Lambert MJ, Burlingame GM, Umphress V, Hansen NB, Vermeersch DA, Clouse GC, & Yanchar SC (1996). The reliability and validity of the Outcome Questionnaire. Clinical Psychology and Psychotherapy, 3, 249-258.
Lindgren A, Barber JP & Sandahl C (2008). Alliance to the group-as-a-whole as a predictor of outcome in psychodynamic group therapy. International journal of the group psychotherapy, 58 (2).
Lo Coco G, Giannone F & Lo Verso G (2006). La ricerca in psicoterapia di gruppo. In: Dazzi N, Lingiardi V & Colli A, La ricerca in psicoterapia. Modelli e Strumenti, Milano: Raffaello Cortina.
Lo Coco G, Prestano C, Gullo S, Di Stefano G, & Lambert MJ (2006) Un primo studio sulla validazione italiana dell'Outcome Questionnaire (OQ-45.2). Ricerca in psicoterapia, 9/1, pp.7-19.
Martin DJ, Garske JP & Davis KM (2000); Relation of the Therapeutic Alliance with Outcome and Other Variables: A Meta-Analytic Review. Journal of Consulting and Clinical Psychology, 68, No. 3, 438-450.
Marziali E, Munroe-Blum H, McCleary L (1997). The contribution of group cohesion and group alliance to the outcome of group psychotherapy. International Journal of Group Psychotherapy. 47/4, 475-497.
Marmarosh C., Holtz A., Schottenbauer M. (2005). Group Cohesiveness, Group-Derived Col-lective Self-Esteem, Group-Derived Hope, and the Well-Being of Group Therapy Members Group Dynamics: Theory, Research, and Practice , 2005, Vol. 9, No. 1, 32–44.
McCallum M, Piper E, Ogrodniczuk JS (2002). Early Process and Dropping Out From Short-Term Group Therapy for Complicated Grief. Group Dynamics: Theory, Research, and Practice. 6/ 3, 243–254.
Piper WE, Marrache M, Lacroix R, Richardsen AM, Jones BD (1983). Cohesion as a basic bond in groups. Human Relations. 36, 93-108.
San Martini P, Roma P, Sarti S, Lingiardi V, Bond M (2004). Italian Version of the Defense Style Questionnaire. Comprehensive Psychiatry. 45/6, 483-494.
Strauss B, Burlingame GM, & Bormann B (2008). Ricerca sul processo della terapia di gruppo. In: Lo Coco G, Prestano C & Lo Verso G (eds.), L'efficacia clinica delle psicoterapie di gruppo, Milano: Raffaello Cortina.
Tasca GA, Illing VA, Ogrodniczuk J & Joyce, A (2009). Assessing and adjusting for dependent observations in group treatment research using multilevel models. Group Dynamics: Theory, Research, and Practice. 13, 151-162.
Tasca GA, Ramsay et al. (2010) Modeling Longitudinal Data From a Rolling Therapy Group Program With Membership Turnover: Does Group Culture Affect Individual Alliance? Group Dynamics: Theory, Research, and Practice. 14, 151–162.
Woody SR & Adessky RS (2002). Therapeutic alliance, group cohesion, and homework com-pliance during cognitive-behavioral group treatment of social phobia. Behavior Therapy, 33, 5–27.Yalom I & Leszcz M (2005). The Theory and Practice of Group Psychotherapy. 5th edition: Basic Books.
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